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An Experimental Survey of Key Factors Involved in Problem-Solving Court Staff Decisions About Medications For Opioid
M H Clark1, Barbara Andraka-Christou2,3, Jill Viglione4
1Department of Learning Sciences and Educational Research, University of Central Florida, Orlando, FL, USA.
Substance Use & Addiction Journal
|August 3, 2026
Summary
Problem-solving court staff are less likely to approve medications for opioid use disorder (MOUD) when clients prefer methadone, seek care from non-partner providers, or have a history of misuse. Building court-MOUD partnerships can increase MOUD access.
Area of Science:
- Public Health
- Addiction Medicine
- Criminal Justice
Background:
- Medications for opioid use disorder (MOUD) are effective but underutilized in problem-solving courts (PSCs).
- Prior research suggests PSC staff make individualized MOUD approval decisions.
- These decisions are influenced by MOUD type and provider partnerships.
Purpose of the Study:
- To experimentally test factors influencing PSC staff decisions on MOUD approval.
- To validate qualitative findings on MOUD decision-making in PSCs.
Main Methods:
- A national online survey experiment with 53 PSC staff.
- Participants rated 8 of 32 hypothetical client vignettes.
- Vignettes varied MOUD type, provider partnership, client history of misuse, race, and gender.
Main Results:
- PSC staff were less likely to approve MOUD for clients preferring methadone over buprenorphine.
- MOUD approval decreased when medication was sought from non-partnering providers.
- Clients with a history of MOUD misuse were less likely to receive approval.
Conclusions:
- PSC staff decisions on MOUD are significantly influenced by MOUD type and provider relationships.
- Developing PSC-MOUD provider partnerships can enhance MOUD utilization.
- Addressing misconceptions about methadone is crucial for increasing access.
Keywords:
buprenorphinedecision-makingfactorial survey experimentmedications for opioid use disordermethadoneproblem-solving courtMore Related Videos
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